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The Problem:
These can be separated into acute, subacute and chronic. Again the issue of the OR depends on the above criteria: focal neurological deficit, decreased level of consciousness, or mass effect causing 5 mm or more of midline shift. Fresh blood on the CT (looks white) means that a craniotomy is needed to evacuate the clot but after about 7-10 days that blood liquefies and can be drained with burr holes. Liquefied blood looks slightly more dense then CSF on the CT.
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What We Do:
Be sure to check the coag status (PTT/INR and CBC) and fix anything you can.
Reverse coumadin promptly with FFP and Vitamin K. Put them on Dilantin and keep them NPO for the first 24 hours.
Links:
Evidence Footnotes:
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